Facing Surgery? Ask About a Nerve Block

Surgery can leave more than a scar on the skin—it often brings lingering pain in the incision and inside the body that’s difficult to ignore. For many years, opioid medications were the standard treatment. But concerns about side effects and addiction have prompted doctors to look for safer ways to control postsurgical pain.

Now, nerve blocks are offering a new path to relief. These targeted injections deliver pain control medication directly to the nerves responsible for pain in the surgical area, numbing the discomfort at its source.

By temporarily blocking those nerves from sending pain signals to the brain, nerve blocks can reduce pain during and after surgery—and in some cases reduce or even eliminate the need for opioid medications.

Pain after surgery is common, especially during the first 24 to 72 hours of recovery. “Typically, when a surgeon makes an incision and operates inside the limb or body cavities, a pain message travels up the spine and to the brain,” says Jinlei Li, MD, PhD, a Yale Medicine anesthesiologist and chief of the Yale New Haven Health Regional Pain Service. “But with nerve blocks, the brain gets less of the pain message, so the patient doesn’t feel that pain.”

The use of nerve blocks has expanded significantly in recent years. They became standard practice for total hip, knee, and shoulder replacements about a decade ago as ultrasound-guided techniques improved. Today, doctors are increasingly using nerve blocks in other procedures as well, including some minimally invasive abdominal and cardiothoracic surgeries, to help manage pain and reduce reliance on opioids.

Pain after surgery can be particularly intense because the procedure affects several layers of the body, including skin, muscles, and sometimes internal organs.

“Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage,” Dr. Li says. “Pain control is intimately linked to surgical outcomes, and chronic pain is the number one cause of disability in the United States.”

The amount of pain someone experiences after surgery can vary depending on the type of the procedure, as well as a person’s age, overall health, and individual sensitivity to pain.

Doctors generally describe two main types of postsurgical pain. Somatic pain comes from the skin, muscles, and soft tissues near the incision and is often sharp or localized. Visceral pain, by contrast, comes from the internal organs and is typically deeper and more cramping or aching in nature. Even procedures that use small incisions—such as laparoscopic or robotic surgeries—can still cause visceral pain to the organs inside the body.

Managing pain well after surgery is important because it can affect recovery. Severe pain may interfere with sleep, increase anxiety, and make it harder for patients to take a normal breath, turn in bed, sit up, use the bathroom, or begin rehabilitation.

“If a patient has a total hip or knee replacement, and pain during recovery hinders their mobility, they could experience stiffness and the new joint may never work properly for them,” Dr. Li says. Pain can also affect the body’s stress response and increase heart rate and blood pressure, which can be especially concerning for people with heart disease.

A nerve block works by temporarily numbing the nerves that carry pain signals from the surgical area.

Before surgery, an anesthesiologist inserts a very thin needle near the targeted nerve. Using real-time ultrasound imaging, they guide the needle carefully to the correct location.

“With ultrasound, we see precisely where the nerves are, but we never inject into one,” Dr. Li says. Doing so could damage a nerve and cause serious side effects. Instead, the medication is injected next to the nerve so it surrounds—or “bathes”—the nerve and temporarily blocks pain signals.

Most nerve blocks contain several medications that work together. A local anesthetic provides the immediate numbing effect that blocks pain signals during and shortly after surgery. An adjuvant, such as a steroid, may be included to reduce inflammation and swelling, while helping to extend how long the block lasts.

“The effects are layered: the local anesthetic will taper off first, followed by the other steroids,” Dr. Li says.

Depending on the medications used, pain relief may last from several hours to 24 hours or longer. After surgery, many patients go home with first-line medications such as acetaminophen (Tylenol), though some may still receive a short prescription for opioids if additional pain control is needed.

Nerve blocks are not used in every operation, and the decision depends on both the procedure and the patient’s overall health. However, their use has expanded as doctors have become more experienced with the technique.

They are widely used in musculoskeletal surgeries, including operations on the shoulder, arm, hand, hip, knee, leg, foot, and ankle. About a decade ago, nerve blocks became common for hip and knee replacements, which was particularly important for older adults who may face higher risks from general anesthesia.

Research shows that patients who receive nerve blocks for musculoskeletal surgery often take less pain medication, not only in the hospital but also after they return home, Dr. Li says.

For spine surgery, doctors at Yale have also been using a type of regional nerve block called an erector spinae plane block.

“We know these are among the most painful procedures,” Dr. Li says. “The block does not take away all the pain, but it helps patients feel better, sleep better, get up sooner, and move around more.”

In recent years, nerve blocks have also been used alongside general anesthesia to improve pain control in other procedures, including gynecologic surgeries such as hysterectomy, operations involving the kidney or bladder, and some cardiac procedures such as coronary artery bypass or mitral valve repair.

In some orthopedic surgeries, a nerve block can eliminate the need for general anesthesia, which puts the patient fully to sleep. In other procedures, the nerve block is used alongside general anesthesia as part of a broader pain-management strategy.

Avoiding general anesthesia can help reduce side effects such as nausea, vomiting, drowsiness, constipation, itching, or breathing difficulties. Nerve blocks are generally considered safe, and when side effects occur they are usually temporary. These may include numbness, soreness, tingling, or weakness.

Depending on the procedure and a patient’s choice, a patient who receives a nerve block may remain awake, be lightly sedated, or drift off to sleep during the surgery.

Some operations—such as most heart surgeries—still require general anesthesia. In those cases, nerve blocks can still play an important role by targeting the nerves that supply the chest wall and improving overall pain control after surgery.

“For many surgeries, a nerve block works best as part of a comprehensive pain plan,” Dr. Li says. “This might include NSAIDs, muscle relaxants, ice, elevation, movement, and occasionally opioids, although often at lower doses than would be needed without the nerve block.”

Because nerve blocks prevent pain signals from reaching the brain, patients often experience less intense pain in the hours after surgery. That can reduce the need for opioid medications, which are known for side effects such as nausea, constipation, drowsiness, and a “cloudy head,” Dr. Li says.

Reducing opioid use has become an important goal in surgical care. In the mid-1990s, pain began to be treated as the “fifth vital sign,” with the goal of eliminating it completely. Over time, doctors realized that this approach sometimes led to excessive reliance on opioid medications.

Dr. Li estimates that 6% to 10% of people in the general population use opioids chronically, often beginning after surgery when pain was not well controlled.

“With the right type and proper duration of regional anesthesia, we’re now seeing patients take fewer opioids on a daily basis and for a shorter duration,” she says. “Their pain scores are much lower than what we were seeing before.”

If you are planning surgery, it’s reasonable to ask your surgeon or anesthesiologist about the pain-control options available for your procedure, including whether a nerve block might be appropriate.

Pain tolerance varies widely between individuals. For example, Dr. Li notes that a younger person may experience more pain than an older adult because nerves gradually degenerate with age.

At the same time, effective pain control is especially important for older patients. It can shorten hospital stays and reduce the risk of complications that sometimes occur during longer recoveries, including infections, pneumonia, or delirium.

“It’s our job to provide each patient with precise, individualized care,” Dr. Li says. “And because patients get to make choices about their care, it’s important for them to know their options.”